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Tori Pierson'." OP ID: YC
<br />CERTIFICATE OF LIABILITY INSURANCE
<br />008/18/1/2021ozl
<br />1
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsements).
<br />PRODUCER
<br />Narver Associates Ins A c
<br />9 y
<br />P.O. Box 1509
<br />San Gabriel, CA 91778.1509
<br />Wesley G. Hampton
<br />CONTACT
<br />NAME: June Samarin
<br />NOONa Est:626-943-2200 A Na:
<br />E-MAIL
<br />ADDREss: jsamarin@narver.com
<br />PRODUCER GRUEN-1
<br />CUSTOMER 10 #:
<br />INSURERS AFFORDING COVERAGE
<br />NAIC #
<br />INSURED Gruen Associates
<br />6330 San Vicente Blvd.,
<br />vd., # 200
<br />Los Angeles, CA 90048
<br />INSURERA: Valley Forge Insurance Company20508
<br />INSURERS: Continental Casualty Company
<br />20443
<br />INsuRERc:National Fire Insurance Co
<br />20478
<br />INSURER D:American Casualty Company
<br />20427
<br />INSURER E :
<br />INSURER F :
<br />:ERTIFICATE NIIMRFR-
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADOL
<br />SUBR
<br />POLICY NUMBER
<br />MM/OCOYVYY
<br />MM,�U/Y YY
<br />LIMITS
<br />A
<br />GENERAL LIABILITY
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1K OCCUR
<br />X
<br />X
<br />6025612892
<br />0610112021
<br />06/0112022
<br />EACH OCCURRENCE
<br />$ 1,000,000
<br />PREMISES eRENaaccurrence
<br />$ 1,000,000
<br />MEDEXP(Anycnepersan)
<br />$ 10,000
<br />PERSONAL 3 ADV INJURY
<br />$ 1,000,000
<br />GENERAL AGGREGATE
<br />$ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER
<br />POLICY X PRO LOC
<br />PRODUCTS - COMP/OPAGG
<br />$ 2,000,000
<br />$
<br />AUTOMOBILE
<br />LIABILITY
<br />ANY AUTO
<br />COMBINED SINGLE LIMIT
<br />(Ea accident)
<br />$ 1,000,000
<br />BODILY INJURY(Per person)
<br />$
<br />ALL OWNED AUTOS
<br />BODILY INJURY (Par accident)
<br />$
<br />SCHEDULED AUTOS
<br />X
<br />PROPERTY DAMAGE
<br />(PER ACCIDENT)
<br />$
<br />C
<br />HIRED AUTOS
<br />6025604615
<br />0610112021
<br />0610112022
<br />C
<br />X
<br />NON-OWNEDAUTOS
<br />6025604615
<br />06/01/2021
<br />0610112022
<br />$
<br />X
<br />UMBRELLA LWB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE
<br />$ 10,000,000
<br />AGGREGATE
<br />$ 10,000,00
<br />6
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />6025612939
<br />06/01/2021
<br />0610112022
<br />[X
<br />DEDUCTIBLE
<br />S
<br />RETENTION $ 10,000
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY YIN
<br />ANY PROPRIETOWPARTNEMEXECUTIVE F-N]
<br />OFFICERIMEMBER EXCLUDED?
<br />NIA
<br />X
<br />6025612939
<br />06101,12021
<br />06/0112022
<br />WCSTATU- OTH-
<br />X T V S
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />E.L. DISEASE-EAEMPLOYEE
<br />$ 1,000,000
<br />H)
<br />(Mandator, NH) nder
<br />If yes.ator, in
<br />E.L. DISEASE -POLICY LIMIT 1
<br />$ 1,000,000
<br />DESCRIPTION OF OPERATIONS below
<br />g
<br />Professional
<br />EHOO8215536
<br />06/01/2021
<br />05/0112022
<br />Per Claim 5,000,000
<br />Liability
<br />Aggregate 5,000,000
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
<br />RE: Agreement Number A-2020-230-07
<br />City of Santa Ana, its officers, employees, agents, volunteers and
<br />representatives are additional insured on a primary and non-contributory
<br />basis as respects attached General Liability endorsement SB146968, as
<br />required by contract. Waiver of subrogation applies as per attached General
<br />CITYSAN
<br />City of Santa Ana
<br />Risk Management Division
<br />20 Civic Center Plaza 4th Fir
<br />Santa Ana, CA 92702
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE wyt R(aL MaaaglARd Dfv4lon
<br />4r 6kvEV,IDi/1PeR01,m8r:
<br />V 1988-2UU9 ACORD CDR
<br />ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
<br />
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